Basic Information
| Provider Information | |||||||||
| NPI: | 1275638728 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMEDLEY | ||||||||
| FirstName: | BERNA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 410 PONCE DE LEON DR | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS VILLAGE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719098121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019221700 | ||||||||
| FaxNumber: | 5019220826 | ||||||||
| Practice Location | |||||||||
| Address1: | 410 PONCE DE LEON DR | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS VILLAGE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719098121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019221700 | ||||||||
| FaxNumber: | 5019220826 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 09/16/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A01653 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | AO1653APN | AR | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 167900758 | 05 | AR | MEDICAID |